The Original Minimally Invasive Hysterectomy, - Safe, Teachable, and More Relevant Today Than Ever
| Autor: | Leslie Kammire, K.T Burchett |
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| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | Journal of Minimally Invasive Gynecology. 28:S51-S52 |
| ISSN: | 1553-4650 2012-2020 |
| Popis: | Study Objective TVH is most minimally invasive hysterectomy, but experience with this is decreasing due to lack of training and emphasis on vaginal approach. Yet competence in vaginal surgery allows one to expand their minimally invasive surgical repertoire, including adoption of vNOTES into their practice, vaginal laparoscopic entry into peritoneal cavity in the difficult surgical abdomen, vaginal morcellation after TLH, and drainage of pelvic abscess vaginally. We present 8 years of data showing that the majority of patients presenting to resident clinic at an academic medical center can safely have a resident performed TVH. The benefits of TVH make it vital to expand teaching of this procedure in residency programs and minimally invasive fellowships. Additional objectives: present ideas to incorporate simulation into TVH training and make intraoperative vaginal teaching easier and safer. Design retrospective review of resident hysterectomy experience with a single academic surgeon from 2012-2020. Setting academic medical center, resident teaching clinic. Patients or Participants women needing hysterectomy. Interventions Hysterectomy, with over 95% of cases performed with resident as primary surgeon. Measurements and Main Results -379 hysterectomies: 63% TVH, 31% LAVH/TLH, 8% abdominal. - Demographics of the 231 TVH patients: 29% obese, 23% morbidly obese, 22% with prior C/S, and 4.7% nulliparous - TVH without morcellation: average time 146 mins, uterine weight 170 gm (27-235). - TVH with morcellation: average time 188 mins, average weight 308 gms(55-895). -TVH complications: • Cystotomy 1.3% • Ureteral or bowel injury - 0 • EBL>1000 1.7% • Urgent conversion 1.2% • Return to OR 0.8% • Surgical site infections: 0.8% • Chronic femoral nerve pain: 0.4% Conclusion TVH is safest, least invasive invasive hysterectomy route, even when performed primarily by resident physicians, with low complication rates. Surveys show recent graduates are more likely to perform and prefer TVH over other approaches when they've had more exposure and experience. Support is needed from national organizations and minimally invasive fellowship programs to increase competence among young physicians. |
| Databáze: | OpenAIRE |
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